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Lönnerfors C, Persson J. Can robotic-assisted surgery support enhanced recovery programs? Best Pract Res Clin Obstet Gynaecol 2023; 90:102366. [PMID: 37356336 DOI: 10.1016/j.bpobgyn.2023.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols comprise a multimodal approach to optimize patient outcome and recovery. ERAS guidelines recommend minimally invasive surgery (MIS) when possible. Key components in MIS include preoperative patient education and optimization; multimodal and narcotic-sparing analgesia; prophylactic measures regarding nausea, infection, and venous thrombosis; maintenance of euvolemia; and promotion of the early activity. ERAS protocols in MIS improve outcome mainly in terms of reduced length of stay and subsequently reduced cost. In addition, ERAS protocols in MIS reduce postoperative pain and nausea, increase patient satisfaction, and might reduce the rate of postoperative complications. Robotic surgery supports ERAS through facilitating MIS in complex procedures where laparotomy is an alternative approach.
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Affiliation(s)
- Celine Lönnerfors
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
| | - Jan Persson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden.
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. Nurs Womens Health 2023; 27:e12-e25. [PMID: 36759284 DOI: 10.1016/j.nwh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. J Obstet Gynecol Neonatal Nurs 2023; 52:e9-e22. [PMID: 36759268 DOI: 10.1016/j.jogn.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Pass or Fail? Postoperative Active Voiding Trials in an Enhanced Recovery Program. Female Pelvic Med Reconstr Surg 2022; 28:436-443. [PMID: 35536662 DOI: 10.1097/spv.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Pelvic reconstructive surgery is often associated with transient postoperative voiding dysfunction. OBJECTIVE This study aimed to compare postoperative active voiding trial (AVT) outcomes before and after implementation of an enhanced recovery program (ERP) for women undergoing pelvic reconstructive surgery. In addition, risk factors for postoperative urinary retention were identified. STUDY DESIGN We retrospectively identified patients undergoing inpatient vaginal or robotic pelvic reconstructive surgery before and after implementation of an ERP at our institution. Demographics, operative and postoperative details, and AVT outcomes were collected. Primary outcome was AVT failure. Variables associated with increased risk of AVT failure were identified using multivariate analysis. RESULTS Three hundred seventeen patients were included-75 pre-ERP and 242 ERP. There was no difference in AVT failures between pre-ERP and ERP groups (21.3% vs 21.9%, P = 0.92). The AVT failures were highest among those with abnormal preoperative postvoid residual volume (PVR ≥100 mL, 25.9% vs 12.2%, P = 0.01) and those who underwent an incontinence procedure (midurethral sling or Kelly plication, 30.4% vs 16.9%, P = 0.01). Compared with a reference procedure (total vaginal hysterectomy [TVH]), the following procedures were associated with statistically significant higher odds ratios (ORs) of AVT failure: TVH with incontinence procedure (OR, 15.0; confidence interval [CI], 4.58-48.9; P < 0.001), TVH with anterior repair (OR, 4.98; CI, 1.93-12.9; P = 0.001), and robotic sacrocolpopexy (OR, 3.6; CI, 1.18-11.2; P = 0.02). CONCLUSIONS Postoperative AVT failure incidence did not differ pre- and post-ERP intervention. Abnormal preoperative PVR was associated with failed postoperative voiding trial. Concomitant incontinence procedures and/or anterior colporrhaphy were associated with increased incidence of voiding trial failure regardless of ERP cohort.
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Dong X, Pan C, Wang D, Shi M, Li Y, Tan X, Guo T. Bladder Backfilling versus Standard Catheter Removal for Trial of Void after Outpatient Laparoscopic Gynecologic Surgery: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021; 29:196-203.e1. [PMID: 34481986 DOI: 10.1016/j.jmig.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the rate of postoperative urinary retention and time to discharge between bladder backfilling and standard catheter removal for trial of void (TOV) after outpatient laparoscopic gynecologic surgery. Our secondary objectives were to compare the time to void, postoperative complications, and patient satisfaction. DATA SOURCES We searched the PubMed, Ovid MEDLINE, Embase, Cochrane Library databases, and relevant reference lists of eligible articles up to March of 2021. METHODS OF STUDY SELECTION This review included randomized controlled trials (RCTs) of TOV after outpatient laparoscopic gynecologic surgery. Odds ratios (ORs) with 95% confidence interval (CI) and weighted mean differences (WMDs) were reported. The quality of the studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data were analyzed with Review Manager 5.4 software (RevMan 5.4.1; Cochrane Collaboration, London, United Kingdom). TABULATION, INTEGRATION, AND RESULTS Five RCTs (N = 488) were included. The bladder backfilling group had a significantly shorter time to void than the standard TOV group (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). Successful TOV was not significantly different between the 2 (OR, 0.92; 95% CI, 0.51 to -1.65; p = .77), without significant heterogeneity (I2 = 24%). There was also no significant difference in the time to discharge between the 2 TOV techniques (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). There was no significant difference in complication rates or patient satisfaction between the 2 groups. CONCLUSION The bladder backfilling technique of TOV after outpatient laparoscopic gynecologic surgery may reduce the time to first spontaneous void without affecting patient satisfaction or postoperative complications, but it does not significantly affect the time to discharge or urinary retention.
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Affiliation(s)
- Xue Dong
- Ambulatory Surgery Department (Dr. Tan and Ms. Dong), West China Second Hospital, Sichuan University, Chengdu
| | - Changqing Pan
- Gynecology and Obstetrics Department, Mianyang Central Hospital (Mr. Pan and Mr. Wang), Mianyang, China
| | - Dan Wang
- Gynecology and Obstetrics Department, Mianyang Central Hospital (Mr. Pan and Mr. Wang), Mianyang, China
| | - Mengdan Shi
- Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu
| | - Yonghong Li
- Gynecology and Obstetrics Department, People's Hospital of Wenjiang District (Mr. Li), Chengdu, China
| | - Xin Tan
- Ambulatory Surgery Department (Dr. Tan and Ms. Dong), West China Second Hospital, Sichuan University, Chengdu; Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu
| | - Tao Guo
- Gynecology and Obstetrics Department (Drs. Shi, Tan and Mr. Guo), West China Second Hospital, Sichuan University, Chengdu.
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Klebanoff JS, Barnes WA, Kazma J, Ingraham CF, Mangini MG, Nishikawa MI, Goldstein NM, Tyan P, Moawad GN. Patterns of voiding following laparoscopic hysterectomy. J Gynecol Obstet Hum Reprod 2021; 50:102126. [PMID: 33775918 DOI: 10.1016/j.jogoh.2021.102126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy. DESIGN Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital. RESULTS 450 minimally invasive hysterectomies were included in the final analysis, 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 min. Based on the 50th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 min) however the difference was not statistically significant (p=.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups. CONCLUSIONS Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 h after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.
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Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Whitney A Barnes
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Caitlin F Ingraham
- Department of Obstetrics and Gynecology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718 - USA
| | - Marissa G Mangini
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Moena I Nishikawa
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Naomi M Goldstein
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA.
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Postoperative Pain and Urinary Retention After Vaginal Reconstructive Surgery. Female Pelvic Med Reconstr Surg 2021; 27:e497-e500. [PMID: 33620911 DOI: 10.1097/spv.0000000000001019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of patients' immediate prevoiding pain level after vaginal pelvic reconstructive surgery on their ability to void. METHODS We conducted a retrospective cohort study of women with and without urinary retention after urogynecologic procedures. Postoperative pain, measured by a visual analog scale, was recorded for each patient before a voiding trial. Demographic, surgical characteristics, prevoiding trial pain, and rate of postoperative urinary retention were compared. Multiple-logistic regression analysis was used with all analyses controlled for univariate variables with a P value of ≤0.1 to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Two-tailed tests were used, with P < 0.05. RESULTS A total of 458 patients were identified, of which 21% (97/458) failed their voiding trial. In our study, 62% (284/458) of women had a voiding trial on postoperative day 1, and 38% (174/458) underwent a same-day voiding trial. No differences were noted between groups comparing race, ethnicity, hysterectomy, urinary sling, estimated surgical blood loss, utilization of intraoperative or postoperative narcotics, or the proportion of same-day voiding trials. Women with postoperative urinary retention had higher mean prevoiding pain when compared with women without urinary retention (pain visual analog scale, 25 mm vs 12 mm [P < 0.001], respectively). After multiple-logistic regression analysis, a significant association between postoperative urinary retention persisted for prevoiding trial pain score (aOR, 1.02; 95% CI, 1.01-1.03), age (aOR, 1.05; 95% CI, 1.02-1.02), and anterior colporrhaphy (aOR, 2.13; 95% CI, 1.18-3.8). CONCLUSIONS Prevoiding pain after pelvic surgery is significantly associated with increased rates of postoperative urinary retention.
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Siedhoff MT, Wright KN, Misal MA, Molina AL, Greene NH. Postoperative Urinary Retention after Benign Gynecologic Surgery with a Liberal versus Strict Voiding Protocol. J Minim Invasive Gynecol 2021; 28:351-357. [PMID: 32652242 PMCID: PMC7790839 DOI: 10.1016/j.jmig.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Surgeons employ various methods for evaluating what is considered a common occurrence after gynecologic operations, postoperative urinary retention (POUR). Few have reported the incidence of POUR with a liberal voiding protocol (no requirement to void before discharge). The primary objective of this study was to evaluate the risk of POUR after benign gynecologic surgery, comparing a liberal voiding protocol with more strict voiding protocols. Secondary outcomes included length of hospital stay (LOS) and urinary tract infection (UTI). DESIGN Retrospective cohort study. SETTING Quaternary-care academic hospital in the United States. PATIENTS Patients undergoing hysterectomy or myomectomy at Cedars-Sinai Medical Center from August 2017 through July 2018 (n = 652). Cases involving incontinence operations, correction of pelvic organ prolapse, malignancy, or peripartum hysterectomy were excluded. INTERVENTIONS Hysterectomy, myomectomy. MEASUREMENTS AND MAIN RESULTS POUR, defined as the need for recatheterization within 24 hours of catheter removal, along with UTI and LOS were compared between liberal and strict voiding protocols. A subgroup analysis was performed for those undergoing minimally invasive surgery (MIS). A total of 303 (46.5%) women underwent surgery with a liberal postoperative voiding protocol and 349 (53.5%) women with a strict voiding protocol. Overall, the incidence of POUR was low at 3.8% and not different between the groups (2.6% liberal vs. 4.9% strict, p = .14). UTIs also occurred infrequently (2.8% overall, 2.6% liberal vs. 2.9% strict, p = .86). Similar results were seen specifically among those who underwent MIS: POUR (3.7% overall, 2.8% liberal vs. 5.3% strict, p = .17) and UTI (3.3% overall, 2.4% liberal vs. 4.7% strict, p = .28). The median LOS (interquartile range) was much shorter for MIS patients with a liberal voiding protocol (median 15 hours overall [interquartile range 15 hours], 9 [4] hours liberal vs. 36 [34] hours strict, p <.01). Among those discharged the same day (72.6% of the MIS cases), patients with a liberal voiding protocol had a significantly shorter LOS than those with strict (mean [standard deviation] 9.4 [2.5] hours vs. 10.6 [35] hours, p <.01). Postoperative complications occurred less frequently in those with MIS procedures (11.8% in MIS vs. 20.2% in laparotomies, p <.01) and those with liberal voiding protocols (11.2% liberal vs. 16.9% strict p = .04). CONCLUSION Overall, POUR occurs infrequently after major benign gynecologic surgery and does not differ between those with liberal and strict voiding protocols. Our data suggest that same-day discharge after MIS hysterectomy and myomectomy without a requirement to void does not increase the risk of POUR and shortens LOS. Eliminating voiding protocols after these procedures may facilitate greater efficiency in the postanesthesia recovery unit and may contribute to enhanced recovery after surgery protocols.
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Affiliation(s)
- Matthew T Siedhoff
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California.
| | - Kelly N Wright
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Meenal A Misal
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrea L Molina
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Naomi H Greene
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
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Misal M, Behbehani S, Yang J, Wasson MN. Is Hysterectomy a Risk Factor for Urinary Retention? A Retrospective Matched Case Control Study. J Minim Invasive Gynecol 2020; 27:1598-1602. [DOI: 10.1016/j.jmig.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
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Patient Discharge without an Order to Void in the Outpatient Gynecologic Surgery Setting. J Minim Invasive Gynecol 2020; 27:1059-1062. [DOI: 10.1016/j.jmig.2019.09.770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
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Smith RB, Mahnert ND, Hu C, Steck-Bayat K, Womack AS, Mourad J. Impact of Retained Cystoscopy Fluid after Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:288-296. [PMID: 32505857 DOI: 10.1016/j.jmig.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To investigate the impact of retained cystoscopy fluid after laparoscopic hysterectomy on time to spontaneous void, time to discharge, urinary retention, bladder discomfort, and patient satisfaction. DESIGN Single-blind randomized controlled trial. SETTING An academic medical center. PATIENTS One hundred and twenty patients who underwent laparoscopic hysterectomy with universal cystoscopy for benign indications, excluding pelvic organ prolapse and urinary incontinence indications. INTERVENTIONS From October 10, 2018, to October 17, 2019, we compared 200 mL retained cystoscopy fluid and complete bladder emptying after laparoscopic hysterectomy with universal cystoscopy. MEASUREMENTS AND MAIN RESULTS A total of 120 patients were enrolled and randomized (59 in the retained cystoscopy fluid group and 61 in the emptied fluid group). The primary outcome was time to first spontaneous void. The secondary outcomes were time to discharge, urinary retention rates, bladder discomfort, and patient satisfaction. A sample size of 120 was calculated to detect a 57-minute difference in time to spontaneous void. There were minimal differences in baseline demographics and surgical characteristics between the groups. There was an apparent, although not significant, difference in time to void of 25 minutes (143 minutes vs 168 minutes, p = .20). Time to discharge and urinary retention rates did not differ (199 minutes vs 214 minutes, p = .40, and 13.6% vs 8.2%, p = .51, respectively). There was no difference in postoperative bladder discomfort and patient satisfaction. CONCLUSION Retained cystoscopy fluid after laparoscopic hysterectomy did not significantly affect time to first spontaneous void, time to discharge, urinary retention, bladder discomfort, or patient satisfaction.
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Affiliation(s)
- Rachael B Smith
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad).
| | - Nichole D Mahnert
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (Dr. Hu), Arizona
| | - Kayvahn Steck-Bayat
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Ashley S Womack
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Jamal Mourad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
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Effects of Acupuncture on Hospitalized Patients with Urinary Retention. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2520483. [PMID: 32051686 PMCID: PMC6995310 DOI: 10.1155/2020/2520483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to investigate the effects of acupuncture on urinary retention and provide treatment suggestions. Methods A total of 113 hospitalized patients with urinary retention were included in this study. The GV20, CV6, CV4, CV3, ST28, SP6, and SP9 points were selected as the main acupoints. Acupuncture therapy was conducted for 30 minutes per session. The total number of treatment sessions was determined by the symptoms and the length of hospital stay. Bladder postvoid residual urine volume (PVR) was measured pretreatment and posttreatment by ultrasonic. Efficacy defined as spontaneous urination and a residual urine volume <50 mL was measured. Results The median number of acupuncture treatment sessions was 3 (range, 1-12 times). Acupuncture treatment significantly reduced the PVR (545.1 ± 23.9 mL vs 67.4 ± 10.7 mL; p < 0.001). Among the 113 patients, 99 (87.6%) patients were cured and 8 (7.1%) patients were improved of their urinary retention. The remaining 6 (5.3%) patients' urinary retention did not improve. The effective rate was 94.7%. There was significant difference in the efficacy rate between patients with one urinary catheterization and with two or more. Acupuncture treatment was not associated with side effects. Conclusion Acupuncture is an effective and safe treatment option for urinary retention. Early application of acupuncture treatment should be considered in clinic, and repeated urinary catheter insertion and removal should be avoided. Our study suggests that a randomized controlled study with a large sample size to verify the efficacy of acupuncture for the treatment of urinary retention is warranted.
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Moawad G, Tyan P, Marfori C, Abi Khalil E, Park D. Effect of postoperative partial bladder filling after minimally invasive hysterectomy on postanesthesia care unit discharge and cost: a single-blinded, randomized controlled trial. Am J Obstet Gynecol 2019; 220:367.e1-367.e7. [PMID: 30639089 DOI: 10.1016/j.ajog.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common surgical procedures performed each year with substantial related health care costs. This trial studied the effect of postoperative bladder backfilling to submicturition level in the operating room and its effect on early postoperative patient care and related cost. OBJECTIVE The objective of the study was to compare the effect of bladder backfilling on early postoperative patient care and related cost. STUDY DESIGN This was a randomized, single-blinded, controlled trial conducted between April 2016 and February 2017 at a single urban university hospital providing tertiary care for minimally invasive gynecologic surgery. Ninety-one patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by minimally invasive gynecologic surgeons for benign indications were recruited. The bladder was partially backfilled with 150 mL of normal saline postoperatively in the intervention group and drained in the control group, as per standard of care. Main outcomes studied were time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit cost after minimally invasive hysterectomy. Our secondary outcomes were postoperative complications. RESULTS Forty-six patients (50.5%) were randomized to the intervention group, and 45 patients (49.5%) to the control group. Baseline comparative analysis of demographics and preoperative patient-specific variables, surgical history, intraoperative characteristics, and administered medications found the 2 groups to be largely homogenous. After regression analyses for adjustment, we found a significant reduction in the time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit-associated cost in the intervention group. Patients voided 64.9 minutes earlier than the control group (P = .015) ans spent 64 fewer minutes in the postanesthesia care unit (P = .006), resulting in $401.5 (USD) saving per patient (P = .006). None of the patients encountered any postoperative complications. CONCLUSION Based on the findings of this randomized clinical trial, postoperative bladder backfilling to submicturition level shortens the time needed for patients to void in the postanesthesia care unit, resulting in shorter postanesthesia care unit stay and resultant cost savings. Conservatively projecting our findings on minimally invasive hysterectomy procedure is estimated to result in $69 million to $139 million (USD) per year in savings. Initiating similar investigations in other ambulatory surgical fields will likely result in a more substantial impact.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC.
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cherie Marfori
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Elias Abi Khalil
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Daniel Park
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
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